Research ArticleOriginal Article

Episiotomy in Low-Risk Vaginal Deliveries

Richard E. Allen and Ronald W. Hanson
The Journal of the American Board of Family Practice January 2005, 18 (1) 8-12; DOI: https://doi.org/10.3122/jabfm.18.1.8

Article Figures & Data

Tables

  • Table 1.

    Demographic Characteristics in Low-Risk Groups by Specialty

    CharacteristicOB* (n = 2318)FP (n = 802)P Value for Difference
    Age [Mean (SD)]26.3 (4.9)25.8 (4.7).01
    Age
        ≤1983 (3%)47 (6%).01
        20 to 342066 (89%)717 (89%)NS
        ≥35169 (7%)38 (5%).01
    Gestational age [mean weeks (SD)]39.0 (1.1)39.0 (1.2)NS
    Parity
        Nulliparous879 (38%)284 (35%)NS
        Multiparous1439 (62%)518 (65%)NS
    Time of day
        7:00 am to 5:59 pm1340 (58%)414 (52%)0.01
        6:00 pm to 10:59 pm445 (19%)169 (21%)NS
        11:00 pm to 6:59 am533 (23%)219 (27%)0.02

    • * OB, obstetrician; FP, family physician; NS, not significant at α = 0.05 level.

  • Table 2.

    Clinical Management and Outcomes by Physician Specialty

    OutcomeOB* (n = 2318)FP (n = 802)Unadjusted Risk Ratio [95% CI]
    Episiotomy1248 (54%)261 (33%)1.65 [1.49 to 1.84]
    Epidural anesthesia2097 (91%)677 (84%)1.07 [1.04 to 1.11]
    Induction742 (32%)193 (24%)1.33 [1.16 to 1.52]
    Forceps extraction342 (15%)34 (4%)3.07 [2.18 to 4.33]
    Vacuum extraction16 (1%)74 (9%)0.08 [0.04 to 0.13]
    Third or fourth degree perineal laceration83 (4%)23 (3%)1.25 [0.79 to 1.97]
    Malposition37 (2%)17 (2%)0.75 [0.43 to 1.33]
    Shoulder dystocia14 (1%)13 (2%)0.37 [0.18 to 0.79]
    Abnormal fetal heart rate/rhythm105 (5%)27 (3%)1.35 [0.89 to 2.04]
    Infant weight >4 kg214 (9%)59 (7%)1.26 [0.95 to 1.66]

    • * OB, obstetrician; FP, family physician; CI, 95% confidence interval.

  • Table 3.

    Multivariate Analysis of Episiotomy Use and Associated Risk Factors

    CharacteristicEpisiotomies (%)Adjusted Odds Ratio* [CI]†
    Practitioner
        FP261 (33%)1.0
        OB1248 (54%)2.38 [1.98 to 2.87]
    Parity
        Multiparous782 (40%)1.0
        Nulliparous727 (63%)2.13 [1.81 to 2.48]
    Anesthesia
        Local or none119 (34%)1.0
        Epidural1390 (50%)1.38 [1.07 to 1.77]
    Induction
        None1040 (48%)1.0
        Induction469 (50%)1.01 [0.85 to 1.19]
    Instrumented delivery
        None1136 (43%)1.0
        Forceps317 (84%)5.08 [3.75 to 6.88]
        Vacuum56 (62%)2.85 [1.78 to 4.58]
    Fetal complications
        None1111 (43%)1.0
        Shoulder dystocia15 (56%)1.92 [0.85 to 4.34]
        Heart rate or rhythm94 (71%)1.22 [0.79 to 1.89]
        Weight >4 kg142 (52%)1.13 [0.86 to 1.48]
    Time of day
        Night324 (43%)1.0
        Day or evening1185 (50%)1.22 [1.02 to 1.45]
    Age
        20 to 341359 (49%)1.0
        Teen67 (52%)0.83 [0.56 to 1.23]
        ≥3583 (40%)0.83 [0.61 to 1.13]

    • * Adjusted for all factors shown in table.

    • † CI, 95% confidence interval; FP, family physician; OB, obstetrician.

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